A Perspective from England

Professor Chris HamChief ExecutiveThe King’s Fund15 May 2014

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

    AUS CAN GER NETH NZ UK US

OVERALL RANKING (2010) 3 6 4 1 5 2 7

Quality Care 4 7 5 2 1 3 6

Effective Care 2 7 6 3 5 1 4

Safe Care 6 5 3 1 4 2 7

Coordinated Care 4 5 7 2 1 3 6

Patient-Centered Care 2 5 3 6 1 7 4

Access 6.5 5 3 1 4 2 6.5

Cost-Related Problem 6 3.5 3.5 2 5 1 7

Timeliness of Care 6 7 2 1 3 4 5

Efficiency 2 6 5 3 4 1 7

Equity 4 5 3 1 6 2 7

Long, Healthy, Productive Lives 1 2 3 4 5 6 7

Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290

Country Rankings

1.00–2.33

2.34–4.66

4.67–7.00

Commonwealth Fund International Ranking

Three main approaches to NHS reform

Targets and performance managementInspection and regulationCompetition and choice

Plus substantial investment from 2000-10

The King’s Fund View

Complementary approaches are needed

Top down and bottom upWorking through hierarchies and networksCollaborating and competingInnovating and standardising

The transformation of the VA from 1995-1999 as a case study

Implications?

Complementary approaches are very demanding of system stewards and organisational leadersSystem stewards in the UK and Canada are inexperienced in steering large systemsPolitics and policy usually work on quite different cyclesOrganisational leaders need time and persistence to achieve sustainable performance improvementBuilding leadership capabilities and skills in quality improvement are often neglected